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Fight Back Against Mass Shootings

January 5, 2017

Short Attention Span Summary

Sad but resolved…
It’s sad that we need to cover an article on mass shootings.  These terrible tragedies seem to be happening more often.  This was a literature search.  The major takeaway points were that in mass casualty civilian shootings, outcomes may be improved by allowing tactical EMS to coordinate rescue near the scene, cross-training multiple types of first responders in hemorrhage control, having expert on-site senior triage of victims, and doing regular simulation training for such events.  Communication and scene safety were some of the biggest challenges identified.

I made up 5 T’s for prehospital management: threat neutralized, tourniquet on, take to safety, triage, transport.

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One way we as a specialty can push back against the evil of these tragic events is to rescue as many salvageable victims as we can.  This means we are going to have to keep practicing mass casualty active shooter simulation scenarios.


Crit Care. 2016 Nov 8;20(1):362.

Pre-hospital management of mass casualty civilian shootings: a systematic literature review.

Turner CD1, Lockey DJ2,3,4, Rehn M3,4,5.

Author information:

1Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK. c.turner@smd11.qmul.ac.uk.

2Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.

3London’s Air Ambulance, Barts Health Trust, London, UK.

4The Norwegian Air Ambulance Foundation, Drøbak, Norway.

5Department of Health Studies, University of Stavanger, Stavanger, Norway.



Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice.


Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings.


From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally.


Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

PMCID: PMC5101656 Free PMC Article

PMID: 27825363 [PubMed – in process]

What are your thoughts?